Case report of patient with neck pain treated with cervical facet joint injections
Introduction
I reviewed a 52 year old gentleman in the Pain Clinic. He had a history of neck and lower back pain. A recent MRI scan had shown a slight cervical intervertebral disc protrusion.
Examination findings
On examination he had occasional tingling in both hands, which was daily and more in the right than the left. On examination of the neck there was a reduction in flexion and marked reduction of extension and lateral rotation produced by pain. Tone and power were NAD and reflexes were reduced on both the left and the right. Light touch was normal.
Medication
He was taking Co-codamol, Co-dydramol and Nortriptyline as required.
My clinical impression was that this gentleman had cervical facet joint tenderness, most likely secondary to a small cervical disc protrusion and secondary myofacial pain syndrome. He also had lumbar facet joint tenderness and I note he had a mini spine operation to remove fibrous tissue from the nerve root and L4.
X ray guided cervical facet joint blocks
In the first instance he was given anti-inflammatories in the form of Etoricoxib 90 mg as required and was booked in for x ray guided cervical facet joint injections. The x ray guided cervical facet joint injections were performed on the left at C3/4, C4/5 and C6/7 and on the right at C4/5 and C6/7. A total of 20mls of 0.5% Bupivacaine and 80 mg of Depo-Medrone were used.
Two month review
He was reviewed in the clinic 2 months later and was doing extremely well. He was off all his analgesics and found the pain had dramatically reduced. He had started his physiotherapy based rehabilitation including aerobic exercises and postural retraining. He found this treatment to be extremely helpful and given the improvement, he was discharged from the clinic.
